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Speakers. Michael T. Rapp, MD, JD, FACEPDirector, Quality Measurement and Health Assessment GroupOffice of Clinical Standards and QualityCenters for Medicare and Medicaid Services. Rita Richardson, MD, FAANMember, AAN Quality Measures and Reporting SubcommitteeMedical Director, Musculoskeletal
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1. 2010 PQRI for Neurologists:
Learn How to Earn Your 2% Bonus
Thursday, March 4, 2010
11:30am-12:30pm ET
2. Speakers Michael T. Rapp, MD, JD, FACEP
Director, Quality Measurement and Health Assessment Group
Office of Clinical Standards and Quality
Centers for Medicare and Medicaid Services Rita Richardson, MD, FAAN
Member, AAN Quality Measures and Reporting Subcommittee
Medical Director, Musculoskeletal Division
Altru Health System, Grand Forks, ND
3. Overview Reporting options
Key elements of PQRI performance measures and specifications
Which measures apply to your practice
How to earn the 2% bonus
Feedback report and incentive payment
Techniques and new tools for PQRI 2010
4. 2010 PQRI The Physician Quality Reporting Initiative (PQRI) program requirements and measure specifications are modified yearly
Voluntary Pay-for-reporting program
Effective January 1, 2010 through December 31, 2010
5. How Do I Participate? Voluntary program
No need to register with CMS
Just start reporting the measures
6. Why participate Future reimbursement tied to outcomes
Neurologists provide high quality, efficient care
Demonstrate the value of that care
2% bonus payment
Preparation for Maintenance of Certification (MOC)
7. PQRI Bonus Earn a 2% bonus payment on your total Medicare Part B Physician Fee Schedule (PFS) allowed charges
Bonus paid to holder of TIN mid-2011; analysis & feedback occurs at NPI level
8. Quality Measure Specifications Denominator – ICD-9 and/or E/M codes identify pts/visits that a measure is applicable
Numerator – CPT II codes translate the clinical actions related to each reported measure
Modifiers – explain rationale behind the clinical action being reported
9. Reporting Methods Claims
Qualified Registry
http://www.cms.hhs.gov/ERxIncentive/Downloads/QualifiedRegistriesPhase1eRx020110.pdf
Qualified EHR
http://www.cms.hhs.gov/ERxIncentive/Downloads/QualifiedEHRVendorsRvsd02022010.pdf
10. New Group Practice Reporting Option A group practice can qualify to earn PQRI incentive payment equal to 2% of the group practice's total estimated Medicare Part B FFS allowed charges for covered professional services furnished during a 2010 PQRI reporting period
http://www.cms.hhs.gov/PQRI/Downloads/GPRO_SelfNominationRequirements_111009.pdf
11. Stroke Measures
14. Retired PQRI Measurement Specifications
15. Example Measure 32: Stroke, Discharged on Antiplatelet Therapy
Eligible patients: Aged 18 or older with ischemic stroke or TIA
Report eligible ICD-9 code from list (e.g., 433.01)
Report CPT code for initial hospital visit (e.g., 99222)
16. CPT II Codes Oral antiplatelet therapy prescribed at discharge
4073F: Oral antiplatelet therapy prescribed at discharge
Oral antiplatelet therapy not prescribed at discharge
4073F-1P: Medical reason for not prescribing oral antiplatelet therapy
4073F-2P: Patient reason for not prescribing oral antiplatelet therapy
4073F-8P: Not prescribed, no reason given
17. 1500 Form – Stroke Reporting
18. Individual Measures Claims-based reporting of individual measures (12 months)
Registry-based reporting of at least 3 individual PQRI measures for 80% of applicable Medicare Part B FFS patients of each eligible professional (6 or 12 months)
EHR based reporting of at least 3 individual PQRI measures for 80% of applicable patients (12 months)
19. Measure Groups – Claims Claims-based reporting of one measures group for:
30 consecutive Medicare Part B FFS patients (12 months)
Claims-based reporting of one measures group for 80% of applicable Medicare Part B FFS patients of each eligible professional
with a minimum of 30 patients during the reporting period (12 months)
with a minimum of 15 patients during the reporting period (6 months)
20. Measure Groups – Registry Registry-based reporting of one measures group for:
30 consecutive patients (patients may include, but may not be exclusively non-Medicare patients)(12 months)
80% of applicable Medicare Part B FFS patients of each eligible professional
with a minimum of 30 patients during the reporting period (12 months)
with a minimum of 15 patients during the reporting period (6 months)
No EHR-based option for measure groups
21. Back Pain Measure Group 13 total Measure Groups-- Back Pain most relevant
Must report all 4 measures
#148: Back Pain: Initial Visit
#149: Back Pain: Physical Exam
#150: Back Pain: Advice for Normal Activities
#151: Back Pain: Advice Against Bed Rest
Claims-based or registry reporting
22. AAN’s Role with Quality Measures Measure Development
Call for Measures through AMA or NQF
Quality Measures and Reporting committee implements process for measure development
Convenes panel
Uses Evidence-based Data
Vetting to physician populations society wide
Submission to AMA or NQF
Current measures at work Epilepsy, Parkinson’s
23. AAN Participation Tools
24. CMS Participation Tools CMS PQRI Website
http://www.cms.hhs.gov/PQRI
CMS PQRI Implementation Guide
http://www.cms.hhs.gov/PQRI/Downloads/2010_PQRI_ImplementationGuide_02-10-2010_FINAL.pdf
25. Questions?
Email p4p@aan.com